When to Obtain Ankle Radiographs

Problems:
- Ankle radiography was the third most common study ordered in the emergency department.
- Majority of patients with ankle radiographs did not receive adequate physical examination before radiographs were obtained.
- Only 17% of extremity radiographs obtained had abnormality that would alter treatment.

Guidelines for Obtaining Ankle Radiographs (Ottawa Rule)

1. Inability to bear weight immediately after the injury OR
   
2. Point tenderness (over medial malleolus, posterior edge or inferior tip of lateral malleolus, talus, calcaneus) OR
   
3. Inability to ambulate for four steps in the emergency room

Sensitivity approaches 100% in excluding significant ankle fractures
Decrease number of ankle and midfoot radiographs by 19% - 36%

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Reference:
ACR Appropriateness Criteria "Suspected Ankle Fracture", revised 2005.